Application

Name *		Address		City

State		Telephone No. *		Email Address *

Date		Box No.		Box Use		Term: No. Months

Name of Business		Name of Renter		Date

Two types of identification must be provided (NO EXCEPTIONS). One must be a picture ID (a photo copy of the picture ID must be obtained).

Furnishing of false or misleading information on this form or omission of information may result in criminal sanctions (including fines and imprisonment) and/or civil sanctions including damages and civil penalties.

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Any person possessing a key or combination to the mail box is considered an authorized user of the box.

Initial Here

Privacy Statement:
The information which you give in completing this form will be forwarded to the designated party for its use and will not be used by YELLOWPAGES.COM for any other purpose or provided by us to any other parties. If you wish information concerning the privacy policy or the designated recipient, you should contact them directly.

* Required to submit this form

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